Suicidal Ideation in Bipolar Disorder: The Relation with Clinical and Sociodemographic Variables

ABSTRACTOver 2.3 million people in the United States live with bipolar disorder. Sixty percent of those with a bipolar disorder diagnosis attempt suicide at least once in their lifetime, and up to 19% die by suicide. However, the neurobiology of suicide attempts in bipolar disorder remains unclear. Here, we studied the neuroanatomical basis for suicide attempt history in bipolar disorder by measuring gray matter volumes (GMV) to identify differences in brain-volumes in 121 participants with bipolar disorder type I, and healthy participants (n=40). The bipolar group consisted of individuals with suicide attempt history (n=23) and no suicide attempt history (n=58). All participants completed behavioral/diagnostic assessments and MRI measures of GMV. We focused on a predefined frontolimbic circuitry in bipolar disorder versus (vs.) healthy to first identify diagnostic GMV markers and to specifically identify markers for suicide attempt history. We found reduced GMV markers for bipolar diagnosis (i.e., bipolar<healthy) in the anterior cingulate cortex (ACC), and dorsolateral prefrontal cortices (DLPFC). Our observed frontolimbic GMV abnormalities were associated with suicide attempt history and measures of individual variations in current suicidal ideation at the time of scanning. These results identified a frontolimbic-GMV marker for bipolar diagnosis and suicidal behavioral risk tendencies.HighlightsSuicide is a major health problem especially in bipolar disorder but the neurobiological basis for suicide attempts remains obscure. We identified an anterior cingulate and dorsolateral prefrontal cortical volume correlate for suicide attempt history and suicidal ideation and thereby demonstrates a convergent brain marker for suicidal behaviors.

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Suicidality in patients with bipolar depression: findings from a lower middle-income country

BJPsych Open ◽

10.1192/bjo.2021.207 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S61-S61

Author(s):

Siqi Xue ◽

John Hodsoll ◽

Ameer Bukhsh Khoso ◽

Muhammad Omair Husain ◽

Imran B Chaudhry ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Ideation ◽

Rating Scale ◽

Bipolar Depression ◽

Demographic Data ◽

Middle Income Country ◽

Income Country ◽

Middle Income ◽

Biological Variables ◽

Lower Middle Income Country

AimsAmong low- and middle-income countries (LMICs), bipolar disorder is recognized as one of the leading causes of disease burden for adults and is associated with marked suicide risk. There are limited data on suicidal ideation in bipolar disorder from LMICs. This study presents cross-sectional data on the prevalence of suicidality and associated patient characteristics among patients with bipolar depression in Pakistan, a lower-middle income country and the fifth most populous country in the world.MethodParticipants were recruited through outpatient psychiatric clinics in between 2016–2019 in Karachi, Lahore, Hyderabad and Rawalpindi between 2016–2019. Participants were aged 18 to 65 years with a known diagnosis of bipolar disorder and currently in a depressive episode. Suicidality was assessed using the suicide item of the 17-item Hamilton Depression Rating Scale (HAM-D) and levels of severity were categorized as absent, mild/moderate, or severe. Biometric data and biomarkers were obtained. Descriptive statistics were used to describe prevalence and proportional odds regression models were applied to establish correlates to suicidal ideation.ResultAmong the 266 participants, 67% indicated suicidality of any level and 16% endorsed severe suicidality. Lower body mass index (BMI) (OR = 0.93, 95% CI = 0.88–0.98), higher HAM-D score (OR = 1.29, 95% CI = 1.16–1.43), lower C-reactive protein (CRP) level (OR = 0.53, 95% CI = 0.40–0.70), and increased number of inpatient hospitalizations (OR = 1.16, 95% CI = 1.03–1.31) were identified as significant predictors of suicidality in the fully adjusted regression model. No patient demographic data, including age, gender, marital status, socioeconomic status, and years of education were associated with severity of suicidality.ConclusionThere exists a high prevalence of suicidal ideation among patients with bipolar depression in Pakistan. Our findings add to the limited literature on suicidality in bipolar disorder in the LMIC context and suggest roles of biological variables such as BMI and CRP level in predicting suicidal ideation and potentially suicidal behaviours in bipolar depression. More studies are needed to see whether such findings can be replicated in other similar LMIC settings, and to explore potential physiological pathways linking BMI, inflammatory biomarkers and suicidality in bipolar disorder.

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Predictors of Suicidal Ideation and Preparatory Behaviors in Individuals With Bipolar Disorder

The Journal of Clinical Psychiatry ◽

10.4088/jcp.20m13371 ◽

2021 ◽

Vol 82 (2) ◽

Author(s):

Laura Palagini ◽

Mario Miniati ◽

Danila Caruso ◽

Andrea Cappelli ◽

Lucia Massa ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Ideation

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Risk factors for suicide attempts in patients with bipolar disorder misdiagnosed with major depressive disorder: results from a national survey in China

10.21203/rs.3.rs-16989/v1 ◽

2020 ◽

Author(s):

Lin Chen ◽

Yu-Yu Xu ◽

Jing-Ge Du ◽

Li-Min Xin ◽

Su-Li Wang ◽

...

Keyword(s):

Risk Factors ◽

Bipolar Disorder ◽

Suicidal Ideation ◽

Clinical Characteristics ◽

Suicide Attempts ◽

Multiple Logistic Regression ◽

Regression Analyses ◽

Major Depressive ◽

Suicide Attempters ◽

Depressive Episodes

Abstract Background: Bipolar disorder (BD) is a kind of mental disorder with the greatest risk of suicide, but it is often misdiagnosed as major depressive disorder (MDD) clinically. This study aimed to analyze the sociodemographic factors and clinical characteristics associated with suicide attempts (SA) in patients with BD misdiagnosed with MDD in China. Methods: A total of 1487 MDD patients were consecutively enrolled in 13 mental health centers in China. Data on patients’ sociodemographic and clinical characteristics were collected using a standardized protocol. Of these, 306 BD patients were misdiagnosed with MDD according to the Mini International Neuropsychiatric Interview (MINI). Suicide attempters and non-attempters were classified by the suicidality module of the MINI. Multiple logistic regression analyses were performed to assess the association between the independent variables of interest and SA in BD patients misdiagnosed with MDD. Results: Of the 306 BD patients misdiagnosed with MDD, 225 (73.5%) were non-attempters and 81 (26.5%) were attempters. Compared to non-attempters, attempters were older (Z =2.2, p = 0.03) and had more admissions(χ2 =6.1, p = 0.013), more frequent depressive episodes, more atypical characteristics (e.g. increased appetite, weight gain, and more sleep time)(χ2 = 5.8, p = 0.016), more suicidal ideation (χ2 = 27.3, p < 0.001), more psychotic symptoms (χ2 = 7.4, p = 0.006) and more seasonal depressive episodes (χ2 = 5.6, p = 0.018). Multiple logistic regression analyses revealed that attempters were characterized by more suicidal ideation (OR = 5.7, 95% CI: 2.6–12.5) and frequent depressive episodes (OR = 2.4, 95% CI: 1.3–4.6). The limitations of this study include its cross-sectional design and data collection by suicide attempters’ retrospective recall. Conclusions: The findings of this study suggest that BD patients misdiagnosed with MDD are at a higher risk of suicide, and more frequent depressive episodes and suicidal ideation are risk factors for attempted suicide. Early identification of and interventions for these risk factors might reduce the risk of suicide in BD patients misdiagnosed with MDD.

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A collaborative therapeutic relationship and risk of suicidal ideation in patients with bipolar disorder

Journal of Affective Disorders ◽

10.1016/j.jad.2008.07.019 ◽

2009 ◽

Vol 115 (1-2) ◽

pp. 246-251 ◽

Cited By ~ 12

Author(s):

Mark A. Ilgen ◽

Ewa K. Czyz ◽

Deborah E. Welsh ◽

John E. Zeber ◽

Mark S. Bauer ◽

...

Keyword(s):

Bipolar Disorder ◽

Suicidal Ideation ◽

Therapeutic Relationship

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White matter abnormalities of corpus callosum in patients with bipolar disorder and suicidal ideation

Annals of General Psychiatry ◽

10.1186/s12991-019-0243-5 ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 2

Author(s):

Ran Zhang ◽

Xiaowei Jiang ◽

Miao Chang ◽

Shengnan Wei ◽

Yanqing Tang ◽

...

Keyword(s):

Bipolar Disorder ◽

White Matter ◽

Suicidal Ideation ◽

Corpus Callosum ◽

Diffusion Tensor ◽

The Body ◽

Pathophysiological Mechanism ◽

The Relationship ◽

Diffusion Tensor Imaging Dti

Abstract Objective Although many studies have shown that the corpus callosum (CC) may play an important role in bipolar disorder (BD) and suicide, the pathophysiological mechanism of BD underlying suicidal behavior is still unclear. This study aimed to explore the relationship between the CC, and BD and suicidal ideation using diffusion tensor imaging (DTI). Method A total of 203 participants (47 BD patients with suicidal ideation, 59 with BD without suicidal ideation, and 97 healthy controls [HC]) underwent DTI scanning at a single site. We examined the white matter integrity of the CC in the three groups. Results A comparison among groups showed that BD patients with suicidal ideation had significant lower fractional anisotropy (FA) values than those of BD without suicidal ideation and HCs in the body and genu of the CC, and FA values of BD without suicidal ideation were significantly lower than those of HCs. However, in the splenium of corpus callosum, no difference was found between BD without suicidal ideation and HCs. Conclusions Our findings add to the evidence suggesting that the CC plays a key role in BD with suicidal ideation, especially with respect to the role of the genu and body of the CC subserving emotion regulation.

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